Healthcare Provider Details

I. General information

NPI: 1578624557
Provider Name (Legal Business Name): KATHY LYNN HOHENBRINK R.D,,L.D.,DC.D.E.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 12TH AVENUE ROAD
NAMPA ID
83686
US

IV. Provider business mailing address

835 W ARBOR POINTE WAY
NAMPA ID
83686-2686
US

V. Phone/Fax

Practice location:
  • Phone: 208-463-5728
  • Fax: 208-463-5725
Mailing address:
  • Phone: 208-318-6239
  • Fax: 208-463-5725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD-027
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: